Senior Program Manager, Public Plans Encounter Data

Mass General Brigham • Somerville, MA

2d • Remote

About The Position

Site: Mass General Brigham Health Plan Holding Company, Inc. Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. Job Summary Responsible for managing all aspects of a large-scale and complex program and corresponding projects, with a primary focus on encounter data operations and vendor program management. Leads and implements initiatives that support alignment with organizational goals and strategic planning. Oversees communication and collaboration with stakeholders across multiple lines of business, external vendors, and government agencies including CMS and state regulators. Develops the program schedule, budget, and various program and project plan details. Analyzes data, prepares reports, and provides regular updates to program leadership. Identifies and escalates issues and risks and recommends solutions. Leads and provides guidance and support to other team members.

Requirements

• Bachelor's Degree required and Master's Degree preferred; experience can be considered in lieu of a degree
• At least 8-10 years of program management experience required
• At least 1-2 years of team leadership experience required
• Strong oral and written communication skills, including the ability to translate complex encounter data and regulatory requirements into clear guidance for technical and non-technical audiences.
• Ability to deliver presentations to a wide variety of audiences.
• Ability to effectively plan and facilitate meetings and workgroups, including cross-functional initiatives involving IT, vendors, and clinical or operational teams.
• Excellent organizational skills and attention to detail, ability to work independently, manage multiple tasks and projects, meet deadlines, and manage to schedule, particularly in a highly regulated environment with concurrent CMS and state submission timelines.

Nice To Haves

• Master's Degree preferred

Responsibilities

• Designs, implements, and manages all aspects of large, complex, multi-disciplinary programs and projects, including end-to-end encounter data submission, 837 EDI workflows, and risk adjustment operations across Medicare Advantage (including D-SNP/One Care) and MassHealth Medicaid.
• Prepares, analyzes, and manages all program budgets, including funding from multiple sources.
• Leads program and project teams and coordinates and delegates cross-project initiatives, in partnership with IT, coding, compliance, actuarial, and vendor partners including Veradigm.
• Conducts research, manages and analyzes data in systems within payer systems and CMS submission platforms including EDS, RAPS, and EDI environments (MAO-002/004 response file resolution), and develops reports and presentations to support programs.
• Identify potential risks, issues, and challenges associated with programs and develop mitigation strategies to minimize impact, with particular focus on CMS acceptance and completeness rate targets, critical error analysis and resolution, and regulatory submission deadlines.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees